274417772-7-22-2024-07-CC-MJVA-D7EUQE-20240722154702

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274417772
Report Date: 07/22/2024
Date Signed: 07/22/2024 03:47:09 PM

Document Has Been Signed on 07/22/2024 03:47 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	ORTIZ-MADRIGAL, MARIELA		FACILITY NUMBER:	274417772
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	07/22/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:02 PM
MET WITH:	Mariela Ortiz-Madrigal		TIME VISIT/ INSPECTION COMPLETED:	04:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Martha Jimenez-Villanueva conducted an announced pre-licensing inspection to the home today. LPA met with Mariela Ortiz-Madrigal, applicant, and explained the nature of today's inspection to her. Applicant, Applicant’s daughters twenty one and eighteen years old were present today. Also present were two children ages twelve and six were present. Applicant states that herself, her husband and her two daughters are the only adults residing in the home. Applicant states that her two children ages 12 and 6 years old also living in the home. The days and hours of operation will be Monday to Friday from 6:00 AM to 5:00 PM. The applicant understands that the children cannot stay in the home for more than 24 continue hours. Applicant has completed her Preventative Health and Safety Child Care Training included the lead poisoning training on 12/08/2023. Applicant's pediatric CPR and First Aid certifications are current and will expire on 05/08/2025. Applicant completed the Mandated Reporter on 05/22/2023. The applicant owns the home and has submitted a copy of the Certificate of Title as proof of control of the property. Applicant states does not have liability insurance for a family childcare home (FCCH) and will use the Affidavit regarding liability insurance for Childcare (form LIC 282). LPA toured the indoor and outdoor areas of the home during today's inspection. The home is clean and orderly, with a central heat and air conditioning to provide ventilation for safety and comfort. There are sufficient toys, supplies, and equipment for day care children. LPA observed the home is one story home. LPA observed no fireplace, no stairs and not bodies of water. Off limits areas in the home are a master bedroom with bathroom and closet, two-bedroom, kitchen, dinner room and laundry area. LPA observed the children area is a fenced dividing the dinner room and children area. Off limits outside the home are the middle of the right side, the back yard and the left side of the house. LPA observed a car port is fenced in the right side. LPA observed in the back yard a fence to divide the area for the dog. LPA observed a fence divided the right side. The play area located in the right side will be used for outdoor activities. There is stairs to access to the back yard. LPA observed no fence in the stairs. Applicant states she has a dog that is vaccinated and stay in the back yard. Applicant has a full fire extinguisher 3A40BC was served on 07/24/2024, and at least one combo smoke detector and carbon monoxide detector is operable. Applicant understands that prior to making any change related to the on or off limits must be reported to Licensing Program. The applicant states that there are no weapons in the home. Applicant understands that cleaning products, toxic agents, medications, and sharp objects shall not be accessible to children, applicant states these products are storage below sink in the kitchen and the laundry area. Report Continues in 809-C page 2.

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ORTIZ-MADRIGAL, MARIELA	FACILITY NUMBER: 274417772
	VISIT DATE: 07/22/2024

NARRATIVE

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Report 809-C page 2.

LPA reminded applicant that smoking, baby walkers, bouncers, jumpers, and similar items are not allowed in Family Child Care Homes.
Forms of discipline applicant will use: Communication with children and redirection. Applicant understands that children's personal rights should not be violated, including no corporal punishment. Isolation of sick children, supervision of children, capacity options for a small license, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, and requirements for assistant/substitute were also discussed. LPA informed applicant that fire/disaster drills must be practiced at least once every 6 months and documented. Department website www.cdss.ca.gov provided to applicant. Applicant understands that children (her own or someone else's) residing in the home count as part of the capacity of her license until they reach the age of ten years old.

LPA discussed the requirements of AB 633 with the applicant. LPAs also discussed "zero tolerance" related regulations with the applicant.

LPA observed proof of immunization for measles, pertussis and opt out form for influenza are in the applicant's file.

A review of staff records on 07/15/2024 indicates that all the adults residing in the home or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

Report continues in 809-C page 3.

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2024

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ORTIZ-MADRIGAL, MARIELA	FACILITY NUMBER: 274417772
	VISIT DATE: 07/22/2024

NARRATIVE

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Report 809-C page 3.

LPA reviewed with applicant, the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant.

LPA discussed the safe sleep regulations with applicant and, discussed the Child Care Licensing Safe Sleep web page at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep, as an additional resource. LPA also informed applicant, of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: https://www.cpsc.gov/, and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

On 02/06/2024 the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

Exit interview conducted and report was reviewed with the applicant Mariela Ortiz-Madrigal in Spanish.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

The applicant was informed that a small Family Child Care Home license will be approved pending on the following:

1. The stairs to access the left and ride side must be barricaded. Submit photo.

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2024

LIC809 (FAS) - (06/04)

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